Provider Demographics
NPI:1346263423
Name:CUSIMANO, GABRIELLE B (PT)
Entity Type:Individual
Prefix:MS
First Name:GABRIELLE
Middle Name:B
Last Name:CUSIMANO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:GABRIELLE
Other - Middle Name:M
Other - Last Name:BLENET
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:1341 SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1419
Mailing Address - Country:US
Mailing Address - Phone:504-885-8969
Mailing Address - Fax:504-885-9190
Practice Address - Street 1:3000 SEVERN AVE
Practice Address - Street 2:SUITE 7
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7605
Practice Address - Country:US
Practice Address - Phone:504-885-8969
Practice Address - Fax:594-885-9190
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA06956225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist